Divisions
Acute Abdominal Pain • Divided into 4 quadrants
• Which organs are in each quadrant?
• What is the function of each organ?
Assessment
Abdominal Pain
• Initial Assessment
• Visceral Pain - crampy, diffuse, aching – note position found - guarded position?
• Somatic Pain – localized, intense, – Look for shock signs
sharp – from irritation of peritoneum • anxiety
• Referred - pain from problem in • rapid / shallow pulse or breathing
another area • low blood pressure (later in assessment)
• distended abdomen (later in assessment)
• Mapping pain may be crucial in initial
diagnosis and tests • Shock signs = Immediate category
– “Surgical Abdomen”
Focused Assessment
Focused Assessment
• Voluntary / Involuntary guarding?
• Rebound tenderness? • Onset?
– Rebound tenderness = immediate category
Possible peritonitis = Surgical Abdomen
• Provocation?
• Masses? - do NOT palpate hard! • Quality?
• Allergies? • Radiation?
• Past Medical History? • Scale?
• Last Oral Intake? • Time?
• Events leading up to this?
Focused Assessment Treatment
• Pertinent Negatives • ABC’s
– Vomiting? • position of comfort - knees to chest, usually
– Last stool? • High flow oxygen - 15 LPM
• When? • Give nothing by mouth
• Blood? (melena or bright red blood) • Rapid transport - signs of bleeding, shock or
– Possible pregnancy? ALWAYS consider rebound tenderness - Surgical Abdomen
pregnancy emergencies with abdominal
pain in a female of childbearing age!!!
…ITISES …ITISES
• Gastritis - stomach lining inflammation • Pancreatitis
– pain after increased acidity – mid / upper quadrant pain, referred to
– often with chronic alcohol, ASA, shoulders?
acetaminophen abuse – increases with alcohol or food intake
– May lead to bleeding – may show shock signs
• Appendicitis - inflammation of appendix • Cholecystitis - gall bladder
– pain from umbilicus to McBurney’s point, N/V, – sudden mid / upper quadrant pain often at night
low fever, chills or with fatty food intake
– may rupture and lead to peritonitis
Acute Abdominal Pains Acute Abdominal Pains
• Obstructions / Impactions • Ulcers
– may be present despite normal bowel – sudden, burning pain
movements – often before meals, at stressful times
– colic type pain – may perforate and bleed
• Urinary Calculi - kidney stones
• Hernia -
– flank pain, radiating to the groin
– sudden onset - usually from lifting or – intermittent with hematuria, restlessness, N/V
straining
– men > women
– fever, tachycardia, chills
Abdominal Aortic Aneurysm
• Sudden onset of
tearing pain
• often radiating to the
back
• pale lower extremities
without pedal pulses
• pulsatile mass in the
abdomen - Do NOT
palpate forcefully